Greater participation in physical therapy leads to improved outcomes
for knee osteoarthritis patients

Unclear if supervised exercise programs are superior to self-directed ones
Exercise therapy is considered a core first-line treatment for managing knee osteoarthritis (OA), which is based on strong evidence that it reduces pain and increases function and quality of life.  One factor that may help predict treatment responsiveness is patient participation, as exercise adherence is crucial for eliciting clinical improvements.  Studies have shown that increased participation may influence the magnitude of an exercise program's impact, but it's still not clear if supervised interventions like physical therapy are necessarily superior to self-directed ones. With this in mind, a study was performed to examine the effects of treatment participation between in-person physical therapy and an internet-based exercise training program (IBET) in knee OA patients.

Secondary analysis performed on original study
The current study was a secondary analysis of an original study performed on knee OA patients randomly assigned to a physical therapy, IBET, or wait list group. Only participants enrolled in active treatments were included here, which equated to 135 participants in the physical therapy group and 124 in the IBET group. The physical therapy program was modeled after standard knee OA care and emphasized active interventions and a home-exercise program, and patients could receive up to eight one-hour sessions. The IBET group was given access to a website with an exercise program and ongoing guidance on tailoring these exercises to facilitate appropriate progression, and patients were encouraged to use it as often as possible. Patients' participation was then analyzed alongside various outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index.

Increased physical therapy participation associated with greater improvements
Results showed that patients who completed more physical therapy sessions had better overall outcomes at the four- and 12-month follow-ups, and the greatest improvements were found among those who attended 6-8 sessions. In several outcomes—including the WOMAC total and function, and two-minute step test—patient retained their improvements until the final follow-up, suggesting that more physical therapy led to a lasting positive impact. Regarding IBET, no statistically significant associations were found between participation in the program and improvements in outcomes, which may have been partially explained by an overall low use of the website. The central finding here is that more physical therapy visits correlated with better outcomes and greater improvements in knee OA patients, while increased IBET participation did not elicit similar responses. This suggests that personal guidance from a physical therapist may play an important role in boosting exercise adherence and thus treatment effectiveness, and clinicians should take note and refer presenting patients to physical therapy accordingly to increase their chances of a positive outcome.

-Summarized by Greg Gargiulo

-As reported in the July '18 issue of BMC Musculoskeletal Disorders